Medicare DSH

Hospitals Sue Over Medicare DSH Payments

Fifteen years ago, a federal court ruled that the Centers for Medicare & Medicaid Services was calculating Medicare disproportionate share payments (Medicare DSH) incorrectly and ordered the agency to fix the problem and reimburse eligible hospitals for the underpayments they had experienced. Now, after 15 years of waiting, 40 of those hospitals are suing for their money. In a suit filed in federal court, the hospitals outline the actions CMS has and has not taken to correct the problem and write that The agency's contractors have not performed the revised determinations required under the ruling and the rule and have [...]

iqtsupport2023-03-21T06:00:22-04:00March 21, 2023|Centers for Medicare & Medicaid Services, Medicare disproportionate share, Medicare DSH, Medicare reimbursement policy|

Federal Health Policy Update for March 16

The following is the latest health policy news from the federal government for March 13-16. Some of the language used below is taken directly from government documents. Medicare Payment Advisory Commission (MedPAC) MedPAC has published its “March 2023 Report to the Congress: Medicare Payment Policy.” In this year’s report MedPAC considers the context of the Medicare program, including the near-term consequences of COVID-19 and the longer-term effects of program spending on the federal budget and the program’s financial sustainability. It evaluates payment adequacy and make recommendations concerning Medicare payment policy in 2024 for selected fee-for-service payment systems but explains that [...]

iqtsupport2023-03-16T17:31:47-04:00March 16, 2023|Centers for Medicare & Medicaid Services, COVID-19, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicare, Medicare disproportionate share, Medicare DSH, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC|

Federal Health Policy Update for January 12

The following is the latest health policy news from the federal government for January 6-12. Some of the language used below is taken directly from government documents. Renewal of COVID-19 Public Health Emergency Declaration HHS Secretary Xavier Becerra has signed an order extending the previous declaration of a COVID-19 public health emergency. This declaration extends the emergency to April 11. The administration continues to assure stakeholders it will provide 60 days’ notice prior to the end of the public health emergency. MedPAC Medicare Rate Recommendations Every year MedPAC recommends to Congress rate increases for the different kinds of health care [...]

iqtsupport2023-01-12T19:22:04-05:00January 12, 2023|Centers for Medicare & Medicaid Services, COVID-19, Medicaid, Medicare, Medicare disproportionate share, Medicare DSH, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC, Telehealth|

Federal Health Policy Update for October 6

The following is the latest health policy news from the federal government for the week of September 26 to October 6. Some of the language used below is taken directly from government documents. 340B HHS must immediately end its significant cut in reimbursement for 340B-covered prescription drugs provided on an outpatient basis to eligible patients, a federal court has ruled, writing that “The prospective portion of the 2022 reimbursement rate shall be vacated because it is defective and because vacating this portion of the 2022 OPPS Rule will not cause substantial disruption” and that “HHS should not be allowed to [...]

iqtsupport2022-10-06T17:42:49-04:00October 6, 2022|340b, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, COVID-19, Medicaid, Medicare, Medicare disproportionate share, Medicare DSH, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC, Telehealth|

Court Rejects Long-Running Medicare DSH Challenge

In a case that challenged a 2005 change in how the federal Centers for Medicare & Medicaid Services calculates Medicare disproportionate share (Medicare DSH) payments, the Supreme Court has, in a 5-4 decision, reversed a lower court ruling and upheld CMS’s policy of counting days of care for which Medicare does not pay in the Medicare fraction of the Medicare DSH percentage – a policy change widely viewed as disadvantageous to hospitals that care for larger numbers of low-income patients. This means that Medicare exhausted days and days of care provided to Medicare enrollees with another source of third-party coverage [...]

iqtsupport2022-06-29T06:00:21-04:00June 29, 2022|Medicare disproportionate share, Medicare DSH|

Federal Health Policy Update for Monday, June 27

The following is the latest health policy news from the federal government as of 2:15 p.m. on Monday, June 27. Some of the language used below is taken directly from government documents. White House The White House COVID-19 response team has briefed the press about the administration’s latest efforts in the response to COVID-19. Find a transcript of that briefing here and find the slides presented during that briefing here. Supreme Court In a case that challenged a 2005 change in how CMS calculates Medicare disproportionate share (Medicare DSH) payments, the Supreme Court has, in a 5-4 decision, reversed a [...]

iqtsupport2022-06-27T16:37:45-04:00June 27, 2022|Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare disproportionate share, Medicare DSH, Medicare post-acute care, Medicare reimbursement policy, Telehealth|

FEDERAL HEALTH POLICY UPDATE FOR FRIDAY, FEBRUARY 25

The following is the latest health policy news from the federal government as of 2:30 p.m. on Friday, February 25. Some of the language used below is taken directly from government documents. Provider Relief Fund HHS made more than $560 million in Provider Relief Fund (PRF) Phase 4 General Distribution payments to more than 4100 providers across the country this week. According to HHS, approximately 86 percent of all Phase 4 applications have now been processed and the remaining applications will continue to be processed throughout early 2022. To date, HHS has distributed $11.5 billion of the $17 billion allocated [...]

iqtsupport2022-02-25T16:45:53-05:00February 25, 2022|ACO, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, health equity, Medicare DSH, Medicare regulations, MedPAC|

Federal Health Policy Update for Friday, July 2

The following is the latest health policy news from the federal government as of 2:45 p.m. on Friday, July 2. Some of the language used below is taken directly from government documents. Supreme Court The Supreme Court has announced that it will hear a case in its next term challenging cuts in 340B payments and another involving Medicare disproportionate share. White House The White House has posted a transcript of the July 1 press briefing given by its COVID-19 response team and public health officials. The transcript includes the announcement that the federal government will be launching surge response teams [...]

iqtsupport2021-07-05T22:53:55-04:00July 5, 2021|340b, Coronavirus, COVID-19, Medicare disproportionate share, Medicare DSH|

CMS Finalizes FY 2021 Payments to Hospitals

Medicare has announced how it will pay hospitals for inpatient care in FY 2021 with publication of its annual inpatient prospective payment system regulation last week. Among the changes announced by the Centers for Medicare & Medicaid Services: A 2.9 percent increase in fee-for-service inpatient rates. A compromise on its proposal to require hospitals to report their payer-specific negotiated rates with Medicare Advantage plans. Changes in how Medicare will calculate Medicare disproportionate share (Medicare DSH) uncompensated care payments. A much smaller cut than originally proposed in the pool of funds for Medicare DSH uncompensated care payments. Minor adjustments in the [...]

iqtsupport2020-09-09T06:00:15-04:00September 9, 2020|hospitals, Medicaid regulations, Medicare disproportionate share, Medicare DSH, Medicare reimbursement policy|

Feds Propose Changing Medicare DSH Calculation

Medicare DSH payments would reflect hospitals’ Medicare Advantage inpatient days under a new regulation proposed by the Centers for Medicare & Medicaid Services. Under the newly proposed rule, the formula for calculating Medicare disproportionate share payments would incorporate hospitals’ Medicare Advantage inpatient days and not just their fee-for-service inpatient days. Medicare DSH payments are made to hospitals that serve especially high proportions of low-income and uninsured patients and are intended to help them with the cost of providing those services. Go here to see the proposed regulation.

iqtsupport2020-08-07T06:00:49-04:00August 7, 2020|Medicare disproportionate share, Medicare DSH, Medicare regulations, Medicare reimbursement policy|